Health Imaging & IT – Integrating RIS/PACS for the Enterprise - (Page 4)

case study: Montefiore Medical Center | Bronx & Westchester County N.Y. on the fly, so that we know instantly whether we need another sequence or whether we need to give contrast if we hadn’t planned to. We literally unfold the diagnosis in real time.” Radiation is delivered on a pixel-by-pixel basis to thousands of tiny pixel size beamlets rather than one or two or four very large crisscrossing beams.” Rapid access to images and systems lets Kalnicki and his team treat patients efficiently and effectively. Other specialties also rely heavily on imaging. “Everything we do in pediatric heart surgery and adult heart surgery as well is based on imaging,” says Samuel Weinstein, MD, chief of pediatric cardiothoracic surgery. Surgeons use images to see the structures they will operate on. And, the entire medical team meets and uses images to discuss the procedure. “We use the PACS to plan out the operations in advance,” he says. The team often creates 3D images to get a better look at an artery or vessel from another angle. Various views also help doctors communicate conditions and procedures to patients. Children with congenital cardiac disease frequently require multiple operations. Weinstein uses the images to help him best manage scar tissue from previous surgeries. He cites a case where a patient’s superior vena cava (SVC) was on the left side rather than the usual right side. Rather than trying to navigate the scar tissue and increase surgery time, Weinstein used past studies to “see that indeed there was a left SVC seen a couple years ago in the patient’s previous study and proceeded with the operation slightly differently. “It not only saved me time in the operating room, but it saved the patient considerable time under anesthesia.” tailored tools Specific tools offered through PACS also ease the workload for physicians. PACS makes it easier for clinicians to manipulate data, says Berkenblit. “For example, we can handle 3D reconstruction imaging in a CT urogram. We’re able to get beautiful reconstruction images in multiple planes, and we’re able to scroll through multiple thin-slice images, looking for tiny lesions in the urinary tract.” tips from the trenches It takes a lot of work and planning to implement an integrated RIS/PACS and reap the benefits. Busy physicians require tailored training at convenient times and communication on progress of the install. And, the organization could not underestimate the impact on physician productivity as they migrated to the new system. “We’ve worked hard to make the physicians comfortable with the technology,” says Gary Kalkut, vice president and senior medical director. Past experience with new systems—Montefiore went live with CPOE in 1999—made the move to integrated RIS/PACS relatively smooth. Significant input from physician working groups helped to pave that path, he says. Plus, “we were extremely flexible in training sessions that were held at different times of the day, individual one-on-one training in addition to group training that was done by attending physicians in the department.” A user-friendly system is essential, according to all of these physicians. “You can navigate from one area of expertise to the other, from MR to CT to radiography all within the same system,” says Weinstein. “It’s all connected, so the ease with which you can maneuver through the system makes it very efficient for any physician.” Effective IT support is vital, says Kalnicki. His department has two embedded IT professionals on a permanent basis. Delays in treatment due to IT problems are kept to a minimum, and when it does, it’s only for a few minutes. Embedding IT experts “within the clinical workflow of our department has solved 99 percent of the existing problems.” An integrated RIS/PACS can’t run on yesterday’s technology, says Weschler. “You really have to look at and inventory your workstations.” Five-year old, 15-inch monitors will not encourage clinicians to adopt a new system. “We looked at every place that [RIS/PACS] was going to effect in the institution, enterprisewise, not just in the [radiology] department.” This kind of solu- Samuel Weinstein, Md, cheif of pediatric cardiothoractic surgery at Children’s Hospital at Montefiore, reviews patient images with a nurse on a RIS/PACS workstation in the ICu. A cross-referencing tool lets different clinicians see the most relevant information in an imaging study, Bello says. For example, with a deep-seated brain tumor, it’s important to get to the right part of the tumor to get the right diagnosis. “You don’t just want to go for the cyst, you want to go for the part that’s going to have the best chance of giving you the answer.” Bello might see that best in one plane, but the surgeon may see the exact trajectory best in another view. Worklist tools offered by RIS/PACS have really helped with efficiency, says Sprayregen. The radiologists try to stay as close to real time as possible with studies performed on inpatients and ED patients. “We have our worklists which can be individualized and allow us to prioritize the work.” For instance, the neuroradiologist and the CT radiologist read the emergency cases first thing in the morning. Then the hospital cases are read. “That’s extremely important both to ED patients and inpatients so that we can move their examinations along and not increase the length of stay.” “The importance of integrating a modern radiation oncology department with imaging cannot be over emphasized,” says Shalom Kalnicki MD, department chair of radiation oncology. “Everything we do now is, by definition, image guided.” That includes tagged localization, tagged motion and management of normal tissue avoidance. “It’s organ by organ, tissue by tissue, tumor by tumor, targeting with pixel beams so every target tissue needs to be identified, contoured, and mathematically analyzed. Integrating RIS/PACS for the Enterprise November 2007

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Health Imaging & IT – Integrating RIS/PACS for the Enterprise Table of Contents Integrated RIS/PACS: Making Work Flow Singular Benefits: Integrated RIS/PACS Delivers Imaging Center Battle Strategies: Combating DRA Spurring Reading Efficiency in a Large Imaging Center Group Creating the Global Imaging Record RIS/PACS for the Community Hospital What’s the Best? Single Vendor vs. Best of Breed

Health Imaging & IT – Integrating RIS/PACS for the Enterprise

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